Assessment of liver fibrosis before and after antiviral therapy by different serum marker panels in patients with chronic hepatitis C

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http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2010.04500.x/abstract

Assessment of liver fibrosis before and after antiviral therapy by different

serum marker panels in patients with chronic hepatitis C

S. M. ez1, G. Fernández-Varo2, P. González1, E. Sampson3, M. Bruguera1,

M. Navasa1, W. Jiménez2, J. M. Sánchez-Tapias1, X. © 2010 Blackwell

Publishing Ltd

Issue

Alimentary Pharmacology & Therapeutics

Early View (Articles online in advance of print)

Author Information

1Liver Unit, Hospital Clinic, IDIBAPS and Ciberehd, Barcelona, Spain.

2Department of Biochemistry and Molecular Genetics, Hospital Clinic, IDIBAPS and

Ciberehd, Barcelona, Spain.

3Siemens Healthcare Diagnostics, Tarrytown, NY, USA.

*Correspondence: Dr X. Forns, Liver Unit, Hospital Clinic, IDIBAPS and Ciberehd,

Villarroel 170, Barcelona 08036, Spain. E-mail: xforns@...

Publication History

Article first published online: 26 OCT 2010

Publication data Submitted 2 July 2010 First decision 22 July 2010 Resubmitted 7

September 2010 Accepted 5 October 2010

Summary

Background  Liver biopsy is the reference standard to assess liver fibrosis in

chronic hepatitis C.

Aim  To validate and compare the diagnostic performance of non-invasive tests

for prediction of liver fibrosis severity and assessed changes in extracellular

matrix markers after antiviral treatment.

Methods  The performances of Forns’ score, AST to platelet ratio index

(APRI), FIB-4 index and Enhanced Liver Fibrosis (ELF) score were validated in

340 patients who underwent antiviral therapy. These scores were determined 24

weeks after treatment in 161 patients.

Results  Forns’ score, APRI, FIB-4 and ELF score showed comparable

diagnostic accuracies for significant fibrosis [area under the receiver

operating characteristic curve (AUROC) 0.83, 0.83, 0.85 and 0.81, respectively].

To identify cirrhosis, FIB-4 index showed a significantly better performance

over APRI and ELF score (AUROC 0.89 vs. 0.83 and 0.82, respectively). ELF score

decreased significantly in patients with sustained virological response (SVR) (P

< 0.0001) but remained unchanged in nonresponders. Non-1 hepatitis C virus (HCV)

genotype, baseline lower HCV RNA, glucose, hyaluronic acid and higher

cholesterol levels were independently associated with SVR.

Conclusions  Simple panel markers and ELF score are accurate at identifying

significant fibrosis and cirrhosis in chronic hepatitis C. A decrease in ELF

score after antiviral treatment reflects the impact of viral clearance in

hepatic extracellular matrix and probably in the improvement of liver fibrosis.

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2010.04500.x/abstract

Assessment of liver fibrosis before and after antiviral therapy by different

serum marker panels in patients with chronic hepatitis C

S. M. ez1, G. Fernández-Varo2, P. González1, E. Sampson3, M. Bruguera1,

M. Navasa1, W. Jiménez2, J. M. Sánchez-Tapias1, X. © 2010 Blackwell

Publishing Ltd

Issue

Alimentary Pharmacology & Therapeutics

Early View (Articles online in advance of print)

Author Information

1Liver Unit, Hospital Clinic, IDIBAPS and Ciberehd, Barcelona, Spain.

2Department of Biochemistry and Molecular Genetics, Hospital Clinic, IDIBAPS and

Ciberehd, Barcelona, Spain.

3Siemens Healthcare Diagnostics, Tarrytown, NY, USA.

*Correspondence: Dr X. Forns, Liver Unit, Hospital Clinic, IDIBAPS and Ciberehd,

Villarroel 170, Barcelona 08036, Spain. E-mail: xforns@...

Publication History

Article first published online: 26 OCT 2010

Publication data Submitted 2 July 2010 First decision 22 July 2010 Resubmitted 7

September 2010 Accepted 5 October 2010

Summary

Background  Liver biopsy is the reference standard to assess liver fibrosis in

chronic hepatitis C.

Aim  To validate and compare the diagnostic performance of non-invasive tests

for prediction of liver fibrosis severity and assessed changes in extracellular

matrix markers after antiviral treatment.

Methods  The performances of Forns’ score, AST to platelet ratio index

(APRI), FIB-4 index and Enhanced Liver Fibrosis (ELF) score were validated in

340 patients who underwent antiviral therapy. These scores were determined 24

weeks after treatment in 161 patients.

Results  Forns’ score, APRI, FIB-4 and ELF score showed comparable

diagnostic accuracies for significant fibrosis [area under the receiver

operating characteristic curve (AUROC) 0.83, 0.83, 0.85 and 0.81, respectively].

To identify cirrhosis, FIB-4 index showed a significantly better performance

over APRI and ELF score (AUROC 0.89 vs. 0.83 and 0.82, respectively). ELF score

decreased significantly in patients with sustained virological response (SVR) (P

< 0.0001) but remained unchanged in nonresponders. Non-1 hepatitis C virus (HCV)

genotype, baseline lower HCV RNA, glucose, hyaluronic acid and higher

cholesterol levels were independently associated with SVR.

Conclusions  Simple panel markers and ELF score are accurate at identifying

significant fibrosis and cirrhosis in chronic hepatitis C. A decrease in ELF

score after antiviral treatment reflects the impact of viral clearance in

hepatic extracellular matrix and probably in the improvement of liver fibrosis.